Shifts in Diagnostic Approaches for Prostate Cancer: Impact of MRI-Informed Biopsies on Low-Risk Cancer Detection.

BACKGROUND

With the shift in prostate cancer (PCa) diagnosis from systematic biopsies to magnetic resonance imaging (MRI)-informed biopsies, we aimed to investigate the changing diagnostic practices of urologists and the impact of MRI on the detection of low-risk PCa.

METHODS

We conducted a retrospective analysis of 698 patients referred for PCa management at the Department of Urology, Kagawa University Hospital, between June 2014 and December 2023. Patients receiving dutasteride treatment (n = 10) were excluded. We assessed longitudinal trends in patient age, PSA levels, utilization rates of digital rectal examination (DRE) and MRI, and the diagnosis of D'Amico low-risk PCa. Predictive factors for low-risk PCa diagnosis were also analyzed.

RESULTS

The median age at diagnosis was 71 years (interquartile range [IQR], 66-76), and the median PSA level was 7.14 ng/mL (IQR, 5.29-12.07), both of which showed a significant upward trend over time (age: R2 = 0.5687, p = 0.012; PSA: R2 = 0.4076, p = 0.047). The frequency of DRE significantly decreased (R2 = 0.8306, p < 0.001), while MRI use increased significantly from 36.4% in 2014 to 92.1% in 2023 (R2 = 0.8960, p < 0.001). Concurrently, the proportion of D'Amico low-risk PCa diagnoses declined from 22.7% in 2014 to 10.5% in 2023 (R2 = 0.6122, p = 0.008). Multivariate logistic regression revealed that MRI-informed biopsies were significantly associated with a reduced likelihood of detecting low-risk PCa (Odds ratio = 0.578, 95% confidence interval = 0.366-0.911, p = 0.018).

CONCLUSION

The increasing use of MRI-informed biopsies in the diagnosis of PCa has shifted clinical practice, potentially contributing to the reduced detection of low-risk PCa.